Heart rate variability analysis to investigate autonomic nervous system activity among the three premature ventricular complex circadian types: An observational study

Background and Objective@#Premature ventricular complex (PVC) burden exhibits one of three circadian types, classified as fast-type, slow-type, and independent-type PVC. It is unknown whether PVC circadian types have different heart rate variability (HRV) parameter values. Therefore, this study aimed to evaluate differences in HRV circadian rhythm among fast-, slow-, and independent-type PVC. @*Methods@#This cross-sectional observational study consecutively recruited 65 idiopathic PVC subjects (23 fast-, 20 slow-, and 22 independent-type) as well as five control subjects. Each subject underwent a 24-hour Holter to examine PVC burden and HRV. HRV analysis included components that primarily reflect global, parasympathetic, and sympathetic activities. Repeated measures analysis of variance was used to compare differences in HRV circadian rhythm by PVC type. Results. The average PVC burden was 15.7%, 8.4%, and 13.6% in fast-, slow-, and independent-type idiopathic PVC subjects, respectively. Global, parasympathetic nervous system, and sympathetic nervous system HRV parameters were significantly lower in independenttype PVC versus fast- and slow-type PVC throughout the day and night. Furthermore, we unexpectedly found that tendency towards sympathetic activity dominance during nighttime was only in independent-type PVC.@*Conclusion@#The HRV parameters are reduced in patients with independent-type PVC compared to fast- and slowtype PVC. Future research is warranted to determine possible differences in the prognosis between the three PVC types.

Large basal cell carcinoma defect closure on the lateral cheek using multiple advancement flaps / Cierre de defecto por carcinoma de células basales en la mejilla lateral usando múltiples flaps de avance

Basal cell carcinoma (BCC) is the most common type of nonmelanoma skin cancer (NMSC). It grows slowly and very rarely metastasizes but can cause substantial morbidity due to its tendency to relapse and locally invasive nature, especially when located on the face. Excision surgery is still the gold standard treatment for primary BCC and is usually followed by reconstruction procedure. Skin flap techniques vary widely, one of which is flap advancement technique. The main benefit of flap advancement technique is the ability to hide the excision line, thus resulting in an aesthetically sound outcome. We report a case of 72-year-old female with hyperpigmented plaque brownish lump on the left lateral cheek. A diagnosis of igmented basal cell carcinoma had been confirmed through histopathological examination. The patient was treated with wide excision surgery and the defectwas closed by multiple advancement flaps. Follow-up after three months showed excellent cosmetic and functional outcome.

El carcinoma basocelular (CBC) es el tipo más común de cáncer de piel no melanoma. Crece lentamente y rara vez hace metástasis, pero puede causar una morbilidad sustancial debido a su ubicación en la cara, tendencia a la recidiva y su comportamiento invasivo local. La cirugía de escisión sigue siendo el tratamiento estándar de oro para el CBC primario y generalmente se acompañan de procedimientos reconstructivos. Las técnicas de flap varían ampliamente, una de las cuales es la técnica de avance del colgajo. El principal beneficio de la técnica de avance es la capacidad de ocultar la línea de escisión y, por lo tanto, se obtiene un resultado más estético. En este artículo reportamos el caso de una mujer de 72 años con placa hiperpigmentada y abultada en su mejilla lateral izquierda. Se había confirmado un diagnóstico de carcinoma de células basales pigmentadas mediante un examen histopatológico. El paciente fue tratado con una amplia cirugía de escisión y el defecto fue cerrado por múltiples colgajos de avance. El seguimiento después de tres meses mostró un excelente resultado cosmético y funcional.

Dental Cement Preparation of Zinc Oxide Eugenol-Ethoxy Benzoic Acid (ZOE-EBA) with Addition of Filler Aluminum Oxide (Al2 O3 )

@#Introduction: The quality of Zinc Oxide Eugenol-Ethoxy Benzoic Acid (ZOE-EBA) dental cement could be improved by the addition of Aluminum Oxide (Al2 O3 ). It was caused by the characteristic of alumina which are easy on fabrication process, resistant on corrosion, endurance usage, bioinert, and biocompatible. The purpose of this study was to determine the effect of the addition of Al2 O3 in ZOE-EBA cement. Methods: Nanoparticle of ZnO (zinc oxide), Al2 O3 , MgO (magnesium oxide),eugenol liquid and EBA (Ethoxy Benzoic Acid) fluid. The variations of Al2 O3 were 24%, 26%, 28%, 30%. First is the sintering on 1000°C and tested by XRD. Sintered powder was mixed with liquid, with a ratio of powder: liquid 7:1. The mechanical characteristic are compressive strength and hardness. Results: XRD test is showed that ZnO has dominant phase on the sample and there was new phase on cement powder such as Zinc-Aluminium oxide (ZnAl2 O4 ). The best result was shown on the addition of 26% of Al2 O3 composition in the 3 type test because the sample had ZnAl2 O4 phase volume fewer than 28% and 30% of Al2 O3 . This result was supported by the compressive strength and hardness which showed the optimum value at concentrations of 26%, which were 64.49 MPa and hardness of 69.33 VHN. Conclusion: Based on the result, it was found that Al2 O3 variation gives the best results in the teeth ZOE-EBA cement was 26%.

Thermal and Mechanical Properties Analysis of Age-Based Human Tooth Enamel

@#Introduction: As the important part of tooth, enamel must be treated well in order to keep its function. The purpose of study is provide tooth composition for various condition and at different ages. Methods: Children (1-2 years), adults (13-40 years), and parents (41-70 years) tooth, aquabidest, abrasive paper, tooth bor, caliper, trimmer, Machines for Hardness test, compressive test and XRD. Each test sample will be cut, mashed, washed and soaked in aquabidest in refrigerator and then to be examined. Results: Micro test results were showed that the main components of the teeth are Hydroxy apatite, Fluorine apatite, and Calcium phosphate hydrate. Transition glass occurs in the age range 1-12 years old at 340o C and in the age range 13-40 years old at a temperature of 400o C , however at the age of 41-70 years old at temperatures of 360o C based on the thermal test results, melting point and boiling point. Mechanical test was showed the level of violence has increased from the age of 1-40 years old then later has decreased, as well as for compressive strength. Hydroxy apatite, Fluorine apatite increase, and Calcium phosphate hydrate decreases in line with age. Tooth enamel also tends to be able to withstand heat in line with age. Conclusion: The level of hardness and tooth strength tends to increase temporarily in older people’s teeth as the calcium content decreases, thus its mechanical strength decreases.

Failure contraception in Indonesia: IDHS 2012 data analysis

Background: Contraception prevalence rate (CPR) increased from the year 1991 is 50% to 62% in 2012 but Totak fertility rate (TFR) was little changed at data IDHS 2002-2003, 2007, and 2012 that is 2.6. Of IDHS 2007, the failure of contraception reflects the result in the unwanted pregnancies that can result in high maternal mortality and morbidity of the baby in the year 2012. The research aims to assess the failure of the contraceptive couples of childbearing age in Indonesia.Methods: Research was the observational study design with a cohort-retrospective. Researchers analyzed longitudinal data using calendar data IDHS 2012. The sample was 10.250 women of childbearing age ever married aged 15-49 years and the use of contraceptives. The analysis of contraceptive failure based on the predictor performed with the cox proportional hazard model by using curves Kaplan-Meier.Results: The most effective contraceptives found that the Implant (0.56) and the IUD (0.75) this was a modern contraceptive. The failure rate of the most high was neither disconnected (8.93) and periodic abstinence (7.32) this is the traditional contraception. The injectable and the pill was the choice of the majority of the respondents. The failure rate of the most high according to modern methods of contraception was injectables (35.67%), while the traditional method is neither disconnected (15.34%).Conclusions: The traditional method was the potential of failure compared to modern methods of contraception that may increase the unwanted pregnancy

Clinical significance of bendopnea in heart failure—Systematic review and meta-analysis

Background Bendopnea is a symptom mediated by increased ventricular filling pressure during bending forward. Presence of bendopnea in patients can be easily evaluated without additional maneuver in several countries whose norms, habits, culture, and occupation relates to a higher frequency of bending forward. This information may prove valuable in routine clinical practice. We aimed to analyze the latest evidence on bendopnea in order to further define the clinical significance of this symptom. Methods We performed a comprehensive search on bendopnea in heart failure from inception up until January 2019 through PubMed, EuropePMC, EBSCOhost, Cochrane Central Database, and ClinicalTrials.gov. Results There were 283 patients (31.76%) who have bendopnea, and a total of 891 patients from six studies were included. Bendopnea was associated with the presence of dyspnea [odds ratio (OR) 69.70 (17.35–280.07); <0.001], orthopnea [OR 3.02 (2.02–4.52); <0.001], paroxysmal nocturnal dyspnea [OR 2.76 (1.76–4.32); <0.001], and abdominal fullness [OR 7.50 (4.15–13.58); <0.001]. Association with elevated jugular venous pressure was shown in two studies. New York Heart Association (NYHA) functional class IV was more prevalent in patients with bendopnea [OR 7.58 (4.35–13.22); <0.001]. Bendopnea was also associated with increased mortality [OR 2.21 (1.34–3.66); 0.002]. Conclusion Bendopnea is associated with the presence of several signs and symptoms. This study also showed that bendopnea is one of the signs and symptoms of advanced heart failure associated with increased mortality. However, owing to the limited number of studies, further investigation is needed before drawing a definite conclusion.

Parasitemia Induces High Plasma Levels of Interleukin-17 (IL-17) and Low Levels of Interleukin-10 (IL-10) and Transforming Growth Factor-ß (TGF-ß) in Pregnant Mice Infected with Malaria

Background: During pregnancy, the balanced dominance of the T helper17 response shifts to a Th2 response that is characterised by the production of IL-10, following the completion of the implantation process. Transforming growth factor-β (TGF-β) expression is associated with the completion of trophoblast invasion and placental growth. This study assessed the effect of malaria infection on the levels of IL-17, IL-10, and TGF-β in the plasma of pregnant mice with malaria. Methods: Seventeen pregnant BALB/C mice were divided into two groups: mice infected with Plasmodium berghei (treatment group) and uninfected mice (control group). The mice were sacrificed on day 18 post-mating. Parasitemia was measured by Giemsa staining. The levels of IL-17, IL-10, and TGF-β were measured by ELISA. Results: Using independent t test, the IL-17 levels in the treatment group were higher than those in the control group (P = 0.040). The IL-10 levels in the treatment group were lower than those in the control group (P = 0.00). There was no significant difference in the TGF-β levels (P = 0.055) between two groups. However, using SEM analysis the degree of parasitemia decreased the plasma TGF-β levels (tcount = 5.148; ≥ ttable = 1.96). SEM analysis showed that a high degree of parasitemia increased the IL-17 levels and decreased the IL-10 and TGF-β levels. Conclusion: Malaria infection during pregnancy interferes with the systemic balance by increasing the IL-17 levels and decreasing the IL-10 and TGF-β levels.

Mycobacterium tuberculosis DNA Increases Vitamin D Receptor mRNA Expression and the Production of Nitric Oxide and Cathelicidin in Human Monocytes

Background: The innate immune response to tuberculosis infection may involve the increased production of nitric oxide and cathelicidin due to the up-regulated expression of the vitamin D receptor (VDR), though this proposed mechanism remains controversial. The aim of this study was to determine how the exposure of human monocytes to Mycobacterium tuberculosis (M. tuberculosis) DNA affects the production of nitric oxide and cathelicidin, as well as the expression of VDR. Methods: This study was performed using monocytes obtained from healthy donors. After 24 h incubation, monocytes were stimulated with M. tuberculosis DNA for 18 h to determine the expression of VDR mRNA and the production of nitric oxide and cathelicidin versus non-stimulated cells (the control group). Results: The expression of VDR mRNA was higher in the monocytes exposed to M. tuberculosis DNA compared to the control group (P = 0.020). Monocytes exposed to M. tuberculosis DNA also showed significantly increased production of nitric oxide and cathelicidin compared to the control group (P = 0.0001; P = 0.028). Conclusion: The stimulation of human monocytes with M. tuberculosis DNA increases the expression of the VDR mRNA and the production of nitric oxide and cathelicidin.

Low Fetal Weight is Directly Caused by Sequestration of Parasites and Indirectly by IL-17 and IL-10 Imbalance in the Placenta of Pregnant Mice with Malaria

The sequestration of infected erythrocytes in the placenta can activate the syncytiotrophoblast to release cytokines that affect the micro-environment and influence the delivery of nutrients and oxygen to fetus. The high level of IL-10 has been reported in the intervillous space and could prevent the pathological effects. There is still no data of Th17 involvement in the pathogenesis of placental malaria. This study was conducted to reveal the influence of placental IL-17 and IL-10 levels on fetal weights in malaria placenta. Seventeen pregnant BALB/C mice were divided into control (8 pregnant mice) and treatment group (9 pregnant mice infected by Plasmodium berghei). Placental specimens stained with hematoxylin and eosin were examined to determine the level of cytoadherence by counting the infected erythrocytes in the intervillous space of placenta. Levels of IL-17 and IL-10 in the placenta were measured using ELISA. All fetuses were weighed by analytical balance. Statistical analysis using Structural Equation Modeling showed that cytoadherence caused an increased level of placental IL-17 and a decreased level of placental IL-10. Cytoadherence also caused low fetal weight. The increased level of placental IL-17 caused low fetal weight, and interestingly low fetal weight was caused by a decrease of placental IL-10. It can be concluded that low fetal weight in placental malaria is directly caused by sequestration of the parasites and indirectly by the local imbalance of IL-17 and IL-10 levels.

Accurate diagnoses, evidence based drugs, and new devices (3 Ds) in heart failure.

Heart failure becomes main problem in cardiology because of increasing of heart failure patients, rehospitalization rate, morbidity, and mortality rate. The main causes of increasing heart failure problems are: (1) Successful treatment of acute myocardial infarction can be life saving, but its sequelae can cause heart failure. (2) Increasing life expectancy rate grows along with incidences of ageing related heart failure. (3) High prevalence of infection in Indonesia can cause rheumatic heart disease post Streptococcal beta hemolyticus infection, viral myocarditis, infective endocartitis, and tuberculoid pericarditis. (4) Many risk factors for coronary heart disease are often found in heart failure patients, for examples smoking, diabetes, hypercholesterolemia, hypertension, and obesity. Indonesia joined international multicentered registry in 2006. Acute Decompensated HEart failure REgistry is a web based international registry to record patient with acute decompensated heart failure treated in emergency room. It was found that heart failure patients in 5 big hospitals in Java and Bali island that joined this registry are younger, sicker and late to seek treatment. The median hospital length of stay was 7 days and in hospital mortality rate was 6.7%. The aim of this article is to give summary about essential things in diagnosing and treating heart failure patients. 3D (accurate diagnoses, evidence based drugs, and new devices) are the most important but what to do and what not to do in dealing with heart failure is also useful for your daily practice.

Transcatheter closure of coronary artery fistula using Guglielmi detachable coil / 老年心脏病学杂志（英文版）

Background Coronary artery fistula (CAF) is a rare anomaly.Transcatheter CAF closure has been introduced using various materials,but only few data are available on the Guglielmi detachable coil (GDC).The advantage of using GDC for transcatheter CAF closure is more controllable,therefore much safer when compared to other coils.This report is about our experience in transcatheter closure of CAF using fibered GDC in our hospital.Methods & Results From 2002 to 2007,there were 10 patients with CAFs (age range:28 to 56 year-old,7 males) who underwent transcatheter CAF closure.There were a total of 19 CAFs which originated from right coronary (n =5),left circumflex (n =3),left anterior descending artery (n =10) and left main trunk (n =1).Median number of coil deployment for each fistula was 3 (range:1 to 6).The pulmonary artery was the most common site of the distal communication of CAFs (n =14),followed by right atrium (n =3),left atrium (n =1) and left ventricle (n =1).Immediate coronary angiography after GDC deployment revealed no residual shunt in 12 (63.2％) CAFs,significant reduction of the flow in 5 (26.3％),while 2 (10.5％) could not be closed due to small size.Nine (90％) patients underwent a repeated angiography within 3 to 8 months.Among 12 CAFs that were occluded immediately post-deployment,there were 2 CAFs with insignificant residual flow.Among 6 CAFs with significantly decreased flow immediately post-deployment,2 were occluded totally in the follow-up angiography.In total,12 (70.5％) CAFs were occluded completely and 5 (29.5％) CAFs still had insignificant residual flow,which did not need any additional coil deployment.During a mean follow up of 4.3 ± 0.7 year,all patients remained symptom and complication free.Conclusions The fibered GDC is a safe and effective method for percutaneous closure of the CAFs.

Cardiocerebral resuscitation: advances in cardiac arrest resuscitation.

Cardiac arrest remains a leading cause of death in the world. Although advances in emergency cardiac care has been achieved, the survival rate of those non hospitalized hospital cardiac arrest remains low. Update in guidelines for CPR and emergency cardiovascular, their approach to out of hospital cardiac arrest is far from optimal. This provides an opportunity to advocate cardiocerebral resuscitation as an alternative to traditional cardiopulmonary resuscitation for non hospitalized cardiac arrest. Because cardiocerebral resuscitation results in improved survival and cerebral function in patients with witnessed cardiac arrest and a shockable rhythm whom have greatest chance of survival, it should replace CPR especially for non hospitalized cardiac arrest.

Effect of beta blocker therapy on survival in severe heart failure.

Beta-blocking agents have been shown to reduce the risk of hospitalization and death in patients with mild to moderate heart failure, but little is known about the efficacy or safety of these agents in severe heart failure. A case of beta blocker administration in severe heart failure with ejection fraction less than 25% is reported. The reported benefits of beta blockers with regard to morbidity and mortality in patients with mild to moderate heart failure were also found in the patient with severe heart failure as reported in this case.

A randomized comparative trial of first-dose response to Angiotensin- Converting Enzyme Perindopril and Captopril in Indonesian heart failure patients.

Several large placebo-controlled trials have confirmed that angiotensin converting enzyme (ACE) inhibitors significantly reduce mortality aid morbidity in all functional grades of congestive heart failure (CHF), nevertheless only a proportion of patients who may benefit from treatment are priscribed an ACE inhibitor. One of the perceived difficulties is the occurrence of first-dose hypotension in susceptible patients. A double-blind, randomised, single-dose therapy, parallel-group study was conducted with the aim to compare the first-dose responses to low dose ACE inhibitors captopril and perindopril in patients with stable chronic heart failure. Seventy patients (New York Heart Association class I-IV) were included. Blood pressure was recorded every 15 minutes 2 hours before starting treatment. The mean of these readings was taken as the baseline blood pressure. Patients were randomised to receive a single-dose of captopril 6.25 mg or perindopril 2 mg. After taking the drug, blood pressure was monitored every 15 minutes for 2 hours, every 30 minutes during 5 hours then hourly after 2 hours. The maximum mean arterial pressure fall from baseline of perindopril was 0.85 mmHg compared to captopril 4.60 mmHg. The maximum mean systolic fall from baseline of perindopril was 3 '31 'mmHg compared to captopril 6.76 mmHg while the maximum mean diastolic fall from baseline of perindopril was 1.08 mmHg compared to captopril 2.63 mmHg. The hypotensive effect of the captopril group started soon after dosing and reached its maximum after 1 to 2 hours while perindopril showed slight reduction of systolic after 1 hour and slight reduction of diastolic after 4 hours. Compared to captopril, perindopril seemed to be less likely to cause first-dose hypotension in patients with heart failure.